Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | AA423970 | MD |
NPI | 1649454174 |
---|---|
Provider Name | Mrs. Joann Lorae Stanger |
First Address | Caldwell, TX 77836-0853 |
Second Address | South Daytona, FL 32119-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 19/12/2007 |